Disaster Mental Health for Responders: Key Principles, Issues and Questions

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NOTE: These materials represent highlights of the kinds of mental-health related information that might be beneficial in a disaster. Because of their brevity, they do not provide an exhaustive, formal review or compilation of the wealth of available knowledge on disaster mental health. This is a starting point. There are companion pieces that provide similar information for city, county and state Public Health officials and as a general primer. Sources of additional information are listed at the end of this document.

Guiding Principles (It is helpful to keep these points in mind when preparing for or responding to a disaster.)

No one who experiences a disaster is untouched by it.
Most people pull together and function during and after a disaster, but their effectiveness is diminished.
Mental health concerns exist in most aspects of preparedness, response and recovery.
Disaster stress and grief reactions are “normal responses to an abnormal situation.”
Survivors respond to active, genuine interest and concern.
Disaster mental health assistance is often more practical than psychological in nature (offering a phone, distributing coffee, listening, encouraging, reassuring, comforting).
Disaster relief assistance may be confusing to disaster survivors. They may experience frustration, anger, and feelings of helplessness related to Federal, State, and non-profit agencies’ disaster assistance programs. They may reject disaster assistance of all types.

Survivor Needs & Reactions (Responses differ, but there are common needs.)

A concern for basic survival
Grief over loss of loved ones and loss of valued/meaningful possessions
Fear and anxiety about personal safety and physical safety of loved ones
Sleep disturbances, often including nightmares and imagery from the disaster
Concerns about relocation and the related isolation or crowded living conditions
A need to talk, often repeatedly, about events and feelings associated with the disaster
A need to feel one is a part of the community and its recovery efforts

Reactions that Signal Possible Need for Mental Health Referral (Many responses to trauma can be expected, but some are cause for extra attention/concern.)

Disorientation (dazed, memory loss, unable to give date/time or recall recent events…)
Depression (pervasive feeling of hopelessness & despair, withdrawal from others…)
Anxiety (constantly on edge, restless, obsessive fear of another disaster…)
Acute psychosis (hearing voices, seeing visions, delusional thinking…)
Inability to care for self (not eating, bathing, changing clothing or handling daily life)
Suicidal or homicidal thoughts or plans
Problematic use of alcohol or drugs
Domestic violence, child abuse or elder abuse

Common Disaster Worker Stress Reaction Checklist (It is not unusual for responders to have these reactions. Check yourself and your buddies.)

Behavioral and Emotional Responses/Symptoms

Anxiety, fear
Grief, guilt, self-doubt, sadness
Irritability, anger, resentment, increased conflicts with friends/family
Feeling overwhelmed, hopeless, despair, depressed
Anticipation of harm to self or others; isolation or social withdrawal
Insomnia
Gait change
Hyper-vigilance; startle reactions
Crying easily
Gallows humor
Ritualistic behavior

Cognitive Responses/Symptoms

Memory loss, Anomia (difficulty naming objects or people)
Calculation difficulties; Decision making difficulties
Confusion in general and/or confusing trivial with major issues
Concentration problems/distractibility
Reduced attention span and/or preoccupation with disaster\
Recurring dreams or nightmares

Physiological Responses/Symptoms

Fatigue
Nausea
Fine motor tremors
Tics
Paresthesia
Profuse Sweating
Dizziness
GI Upset
Heart Palpitations
Choking or smothering sensation

Mis-Attribution of Normal Arousal (Misinterpretation of normal physiological responses can increase anxiety and the number of unnecessary ER visits.)

Interpretation of normal physiological arousal as serious illness
Misinterpretation often is increased by rumors and false information
Increased by hyper-suggestibility in victim fueled by changes in routine and surroundings
Risk communication and rumor control can help reduce unnecessary drains on healthcare

Longer-Term Effects Checklist (Potential down-stream consequences of exposure to a natural or human-caused disaster.)

Nightmares
Intrusive thoughts
Uncontrolled affect
Relationship problems
Job/school related problems
Decreased libido
Appetite change
Blame assignation
Decreased immune response

Sources of Stress for Responders Checklist (These can increase stress.)

Role ambiguity
Lack of clarity of tasking
Mismatching skills with tasks
Lack of team cohesion
Discomfort with hazardous exposure
Ineffective communication within team, with non-team members, with headquarters
Lack of or too much autonomy
Intense local needs for information (media/health officials) that cannot await clearance delay
Database issues, linkage between epidemiology, laboratory, and environmental sampling
Laboratory specimen tracking, reporting
Resources/equipment shortages
Command and control ambiguities
Re-integration barriers
Coworkers had to pick up your work…or no one did and it is overwhelming
Lack of understanding of or appreciation for what you have been through
Domestic/family conflict

Individual Approaches to Avoid/Reduce Stress Checklist (Things you can do to help maintain your own mental, emotional, physical, spiritual balance.)